It's Tuesday. "Pulsin' time. You don’t have to go home, but you can't stay here."

SIGN IT, THEN TWEAK IT – President Obama will sign landmark health reform legislation into law today and Senate Democrats will get down to the business of changing it. Senate Majority Leader Harry Reid is expected to begin debate today on a reconciliation bill designed to fix many of the new law’s flaws. Democrats got good news Monday when the Senate parliamentarian tossed out a Republican challenge to the reconciliation bill’s Cadillac tax provision. Republicans had argued that the provision delaying the tax was out of order. The parliamentarian disagreed. But Republicans remained undeterred, promising to try to eliminate as many of the bill’s provisions as possible. If they are successful, Republicans will force the House to vote on the bill again before it can be sent to Obama for his signature.

HISTORIC BILL SIGNING – President Obama signs health care reform into law at 11:15 a.m. today in the East Room of the White House. He then travels to the Interior Department to discuss health reform at 12:05 p.m.

CBS NEWS POLL:
--“Asked why Democrats worked to pass a health care bill, 57 percent said ‘mostly political reasons.’ Just 35 percent said it was because Democrats think the bill is good policy.”

--“A majority of Americans said the passage of health care reform would be an accomplishment for President Obama, a new CBS News poll shows, even though most people disapproved of the way he has handled the issue and are skeptical of the bill's benefits. Fifty-five percent of Americans called passing the legislation an accomplishment for the president, the poll found.”

GOOD NEWS FOR SENATE DEMS – POLITICO’s Manu Raju reports: “A ruling by Senate parliamentarian Alan Frumin handed Democrats a major victory Monday night, beating back a GOP push to declare a key tax proposal in the health care bill out of order. After hearing arguments on both sides, Frumin said that Democratic plans to push back an excise tax on so-called Cadillac insurance plans until 2018 was within the purview of budget rules allowable under the filibuster-proof reconciliation process. The GOP had challenged the language on the grounds that it violated a 1974 budget law because of its impact on the Social Security statute, and was thus subject to a point of order that would doom the bill in the Senate.”

W.H. ASSURES AMA: DOC FIX COMING THIS SPRING – Inside Health Policy’s Brett Coughlin reports: “A board member of the American Medical Association has twice been assured personally that the White House will continue to push for a repeal of the Medicare physician payment formula this spring after health reform passes, according to a source who was on an AMA conference call Friday.” $5

SELLING REFORM – POLITICO’s Jonathan Allen, Carol E. Lee and Patrick O’Connor report: “Republicans predicted the new law would enact the demise of the Democratic-led Congress in November. President Barack Obama and fellow Democrats began the tough work of flipping the negative polls upside-down — a goal they say will be realized when the first few benefits of the new law kick in. And both sides laid out their strategies for the fall midterm campaign — the same strategies that brought them here, only more and louder. Republicans, right now, can feel they’re on the side of the voters, who polls show simply don’t like the overarching bill. A CNN poll Monday showed 59 percent of voters oppose the reform bill passed by the House late Sunday, compared with 39 percent who support it.”

THE DRAWBACKS OF GOP UNITY – NYT’s Adam Nagourney reports: “Passage of the health care legislation challenges the heart of the Republicans’ strategy this year: To present a unified opposition to big Democratic ideas, in this case expressed in a stream of bristling anger and occasional mischaracterizations of what the bill would do. From a legislative perspective, the Republican strategy did not work, despite months of predictions from Republicans that the bill would fail and that that would cripple Mr. Obama’s presidency. … In a week when Democrats are celebrating the passage of a historic piece of legislation, Republicans find themselves again being portrayed as the party of no, associated with being on the losing side of an often acrid debate and failing to offer a persuasive alternative agenda.”

YOU'VE HEARD ABOUT IT FOR MONTHS – WaPo’s Ceci Connolly’s 4,600 word tick-tock has arrived: “It was the Barack Obama the American public rarely sees -- irritated and wondering if he had arrived at the moment of defeat. Shortly after 6 p.m. on Jan. 19, with a political crisis about to explode, the president summoned the two top Democrats in Congress to the Oval Office for a strategy session. House Speaker Nancy Pelosi (D-Calif.) sat alongside Senate Majority Leader Harry M. Reid (D-Nev.), the tension in the room acute. … Mathematically, Scott Brown's impending victory would deny Democrats a filibuster-proof majority in the Senate. With only 59 votes loosely under his control, Reid wanted the House to adopt the version of the health-care bill that had barely squeaked through the Senate on Christmas Eve. No way, said Pelosi. … As the next 61 days would show, culminating in Sunday night's historic vote, the fate of the legislation ultimately rested in the hands of Obama, who in the hours before Brown's victory was growing increasingly frustrated as Pelosi detailed why no answer was in sight. There went health-care reform. There went history. ‘I understand that, Nancy,’ he finally snapped. ‘What's your solution?’”

REPEAL BACK AGAIN – NYT’s David Herszenhorn and Robert Pear report: “As jubilant Democrats prepared for President Obama to sign their landmark health care legislation in a big ceremony at the White House, Republicans opened a campaign on Monday to repeal the legislation and to use it as a weapon in this year’s hotly contested midterm elections.”

A REFORM ANGLE YOU HAVEN’T THOUGHT OF – POLITICO’s Laura Rozen and Ben Smith report: “When (Israel’s Benjamin Netanyahu) goes to the White House on Tuesday night, he’ll find Obama at the moment of his administration’s greatest success, a shift that may affect Obama’s negotiating power in ways both subtle and dramatic. Obama’s health care victory may prove a decisive pivot point in the way he is viewed both domestically and abroad and in how powerful a negotiator he is perceived to be by foreign leaders. And nowhere is that true more than in Israel, a place obsessed with American politics. ‘Every time I met with an Arab diplomat or anyone from the Middle East, including Israelis, they would invariably ask me, ‘How’s health care going?’’ said former Rep. Robert Wexler (D-Fla.), who retired in December to become president of the S. Daniel Abraham Center for Middle East Peace. ‘And the first couple [of] times, I didn’t really realize what they were actually asking. They were asking, ‘How strong is the president of the United States?’’”

LEGAL CHALLENGES – NYT’s John Schwartz reports: “Officials in a dozen states who oppose the health care bill say they hope to block it in court by arguing that requiring people to buy health insurance is an unprecedented intrusion by the federal government into people’s lives — the equivalent of going a step beyond simply regulating automobiles to requiring people to buy a car.”

THE LOBBYING – POLITICO’s Frates reports: “The doctors who supported the bill had worked for weeks to exempt physicians from the binding cost-cutting recommendations of the measure’s independent Medicare payment advisory board. But they were losing the argument. So, as the final vote drew near, the doctors changed tactics and began lobbying lawmakers to include hospitals in the board’s cost-cutting recommendations, said a lobbyist with a doctors’ group that supported the bill. The hospitals, which cut a $155-billion deal with Democrats to help pay for reform, had received a carve-out. … Doctors lost that fight, too. Hospitals kept their carve-out. … Doctors were also hamstrung by internal divisions that prevented them from speaking with a unified voice. By and large, primary care groups supported the legislation, while surgical organizations opposed it, lobbyists said. In the weeks leading up to the vote, the smaller surgical groups continued to lobby against the bill, but they weren’t big enough to stop the legislation’s momentum, a lobbyist with one of the groups said.”

ABORTION – WSJ’s Laura Meckler reports: “The health-care revamp will allow women to buy abortion coverage when they shop for insurance in government-run exchanges. But new requirements for offering such coverage may lead few insurers to offer it. To sell a plan in the exchanges that covers abortion, insurers will have to collect two checks from customers—one to pay for the abortion coverage, and one to pay for everything else. They will have to keep the funds separate in order to assure that federal aid handed out to consumers doesn't subsidize the procedure, maintaining a long-standing federal principle.” Subscription

REFORM AS A PROXY – WaPo’s Dan Balz reports: “Other issues, such as the economy, may loom larger by November than the heated debate that has raged for more than a year over Obama's health-care initiative. But health care will become a proxy, say strategists in both parties, for the continuing debate over whether the Obama era represents a return to bigger and more intrusive government.”

IMPLEMENTATION – WSJ’s Avery Johnson and Janet Adamy report: “With the health bill passed, the focus now turns to enacting the most-massive changes to the health system in more than four decades. That task will be made difficult by a tight window for launching the first provisions of the bill, and a contentious relationship between government and industry. After the White House spent months sparring with insurers, government health officials must seek their cooperation to put in place the overhaul. Insurers, meanwhile, are hoping the implementation process will offer them an opportunity to influence the overhaul of their industry.” Subscription

PULSE OP-ED:

WSJ editorial: “Many Republicans are already calling for ‘repeal’ of ObamaCare, and that's fine with us, though they should also be honest with voters about the prospects. The GOP can't repeal anything as long as Mr. Obama is President, even if they take back Congress in November. That will take two large electoral victories in a row. What they can do now is take credit for fighting on principle, hold Democrats accountable for their votes and the consequences, and pledge if elected in November to stop cold Mr. Obama's march to ever-larger government.”

NYT's David Brooks: “The task ahead is to save this country from stagnation and fiscal ruin. … The Democratic Party, as it revealed of itself over the past year, does not seem to be up to that coming challenge (neither is the Republican Party). This country is in the position of a free-spending family careening toward bankruptcy that at the last moment announced that it was giving a gigantic new gift to charity. You admire the act of generosity, but you wish they had sold a few of the Mercedes to pay for it.”

WaPo editorial: “In the longer term, though, the most important variable will be whether reform does, as promised, ‘bend the curve’: whether it slows the rate of growth of health-care costs, which on their current trajectory will bankrupt the country. On that will depend whether reform can fulfill its admirable promise of guaranteeing health care for virtually all Americans. One key to that is whether Congress allows an excise tax on expensive health-care plans to take effect in 2018, as written into the bill. The other is how quickly and skillfully the administration seizes on those seeds of reform and nurtures them.”

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Instead of maintaining an ugly and counterproductive HCR obstruction, what if GOP proposes a positive, bipartisan improvement? What if they eliminated the mandate and added Medicare buy-in at cost? Instead of mandate, what if insurers were required to offer guaranteed-issue, community-rated plans to any insured individual who has maintained continuous coverage, regardless of health condition? It is outrageous that people who have maintained coverage can't shop for a better deal if they develop a condition after paying for insurance. What if uninsured people had to wait for coverage or pay a significant penalty if they get sick before they apply for insurance? Wouldn't that promote a sense of personal responsibility? If individuals were allowed to purchase Medicare at cost, wouldn't that promote competition and reduce premiums without increasing cost to government? Couldn't that be done today? Wouldn't GOP be seen as "do-something fixers" instead of "do-nothing destroyers" if they removed the mandate without eliminating other important benefits to constituents, and added Medicare buy-in? Are you out there, Scott Brown?

Where do I begin. I will begin at the beginning of my married life in 1957. By the year 1968, and three children later, my dearest ex-husband decided that he no longer loved me and as I was undergoing a very extensive and serious surgery of removing my pancreas and spleen, he decided to tell me that he will be leaving me when I get home and moved back home with his mother. That was the beginning. At the age of 32, I was penniless, had the responsibility of raising three children, ages, 6,7and 8, and he called the electric co., phone co, and all the utility companies and told them that he was no longer responsibe for any of these bills. I received this call from each of them telling me that they will turn off all my utilities because my ex was no longer responsibile, I in turn said I have three children to care for and I would be responsible; although, I did not know how I was going to pay for them. I proceeded to apply for Welfare, much to my chagrin, and started looking for work to support my family. I worked at several different jobs until I became an Executive Secretary at a non-profit agency and stayed there for 34 yrs. The three of us worked together all these 34 years the CEO, Exec. Dir and Me, Sec. By the way, the beginning, when I went on welfare, just to let you know, I had to pay back the amount I owed for my welfare because I owned a home. I finally retired at the age of 73, one year ago last May, at which time it was necessary because my health finally caught up to me. Where am I now. In the past year, I'm going back and forth trying to figure out the best way to sustain my health insurance and finances. I really don't know. You see, I'm now on medicare. During those 34 years, I did remarry and did pay my welfare debt, kept my home and raised my family and tried very hard to save money from my earnings for a pension because there was no healthcare or pension provisions once I retired. When this began, I did not know about the donut hole, nor did not know I had to pay taxes on my Social Security, although I already had that taken out of my salary. What does this new Health Care do for me????? I really don't know. I will still have to pay for the donut hole, I will still have to pay taxes on my social security, and what little pension I saved, and also pay for Plan B for my Medicare, of which I'm not sure if it may go up next year, However, in order to get some coverage for what the Medicare does not pay, I had to get a supplemental insurance to help pay for the diffrences. Along with this supplement insurance I must pay a premium, a co-pay for doctors,hospital, any procedures needed, etc. and the best of all, my prescriptions until I reach the donut hole and must pay 100% for my prescriptions until I reach the balance of over $4000, and then they are willing to help at a discount. With all this about health insurance and tax rebates, no one even thinks about the senior citizen who, by the way, is on a fixed income. And in the kindness of their heart will reburse us $250 maybe. Isn't that great, after all the other bills we pay. And still have to pay all these taxes on my very small pension I worked so hard to save, my small Social Security allowance income and continue to struggle with my health insurance. Please tell me what must senior citizens do? Did you not have a mother and father also. Won't you grow old someday, maybe? It's not that I don't agree that we do need something to happen with health care and the finances in today's market and the future of our children, but please tell me, did anyone think about the fixed income of senior citizens.